The present study was undertaken to evaluate the efficacy of radiotherapy in palliation of dysphagia in patients with squamous cell carcinoma (SCC) of esophagus and to see the quality of life (QoL) following radiotherapy. This was a prospective clinical study done between September 2006 and May 2008. All consecutive patients with SCC of the esophagus, who are not candidates for definitive treatment, were included in the study. Dysphagia and QoL were assessed using modified Takita's grading and modified questionnaire based on EORTC QLQ 30 respectively. External beam radiotherapy (EBRT) was delivered to all patients using linear accelerator 6 Mv photons. Patients who had good response with EBRT were further subjected to intraluminal brachytherapy (ILBT) at 700 cGy using Iridium-192. The cumulative dose each patient received was 65 Gy. Patients were followed up at 6 weeks from completion of treatment to look for any difference in dysphagia grade and QoL following therapy. Thirty-three patients were included in the study. The mean age among males and females was 60.9 and 49.8 years, respectively. Nineteen patients (57.6 %) received EBRT followed by ILBT; the remaining patients received only EBRT. Seven were lost during follow-up, and seven (21.2 %) died during the study period of 6 weeks. Nineteen (57.6 %) were followed up. On follow-up endoscopy, evidence of residual stricture was observed in 57.9 %, and growth in 36.8 %. Of the patients, 27.8 % had biopsy-confirmed residual disease. The median dysphagia score decreased from 4 to 3 after treatment (p = 0.002) in 17 (89.5 %) patients. The mean QoL score improved from 107.5 to 114.1 at 6-week follow-up. Following radiotherapy, 26.3 % had persistent chest pain, increased cough with expectoration in 15.8 %, and hyperpigmentation of skin in 10.5 %. Radiotherapy gives significant relief of dysphagia and improves QoL in 90 % of patients with SCC of esophagus. However, following radiotherapy, a number of patients will have persistent stricture, ulceration, and residual disease.

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Obturator hernia is an extremely rare type of abdominal wall hernia occurring mostly in elderly, thin females. It is characterized by the herniation of intra-abdominal contents through the obturator foramen. Symptoms are often nonspecific, and the patient usually presents with an acute or subacute intestinal obstruction. A high index of suspicion is needed in such females presenting with abdominal distention and positive Howship-Romberg signs. Computed tomography of the abdomen and pelvis are often necessary to arrive at a diagnosis, and immediate surgical intervention is recommended. The high postoperative morbidity and mortality are often attributed to a delay in the diagnosis and in initiating treatment. We present a case of a 65-year-old lady with strangulated obturator hernia who underwent emergent, lower midline laparotomy with resection and anastomosis of the small bowel and purse-string repair of the hernial defect.

INTRODUCTIONGastric cancer remains the second most common cause of death from cancer worldwide.1,2 Peritoneal metastasis is the most frequent pattern of disease failure after curative resection of gastric cancer.3,4 Detection of these deposits and free cancer cells are necessary for predicting the risk of recurrence and prognostication. 3,4 While CECT scan remains the most widely used imaging technique for preoperative assessment, its sensitivity for detecting the peritoneal metastasis has been found to be low. 5,6 Diagnostic laparoscopy has been found to be effective in detecting this unsuspected peritoneal metastasis and avoid unnecessary laparotomies in recent studies. Hence the study was conducted to compare the efficacy of CECT and diagnostic laparoscopy in detecting unsuspected peritoneal metastasis in gastric carcinoma. ABSTRACTBackground: Gastric cancer remains the second most common cause of death from cancer worldwide. Peritoneal metastasis is the most frequent pattern of disease failure after curative resection of gastric cancer. Detection of these deposits and free cancer cells are necessary for predicting the risk of recurrence and prognostication. Methods: The study was conducted in Department of Surgery from October 2011 to July 2013. The study was designed as a prospective comparative study. All the patients diagnosed with gastric cancer by upper gastrointestinal endoscopy guided biopsy and not having clinical and / or radiological evidence of distant metastasis were included in the study. All patients underwent contrast enhanced computed tomography pre-operatively to detect metastatic disease or advanced gastric cancer. Subsequently the patients were planned for diagnostic laparoscopy followed by appropriate surgery. Sensitivities of the procedure in detecting peritoneal metastases was calculated and compared. Results: A total of 35 gastric cancer patients who met the inclusion and exclusion criteria were recruited in the study. The mean age of these patients was 53.5 years. Diagnostic laparoscopy detected 11 cases of metastatic diseases which were not picked up by CECT, which was statistically significant (p <0.05). Diagnostic laparoscopy showed adjacent organ infiltration in 18 patients, 9 of which were also identified on CT scan. Difference in detection of adjacent organ infiltration was not statistically significant. Infiltration of the serosal surface was seen in 31 patients and 9 of them were identified on CECT scan. Conclusions: Diagnostic laparoscopy is more sensitive and specific than current generation MDCT in detecting peritoneal metastasis and liver surface nodules in cases of gastric cancer. Diagnostic laparoscopy is also more specific in diagnosing the local infiltration into adjacent organs.

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